Hinny Shots and Anal Puckering

As some of you may know, there is a novel flu strain out there called H1N1, or, less accurately, Swine Flu. As others of you may also know, there is a vaccine available that is recommended for the following high risk groups:

• Children/young adults between the ages of 6 months and 24 years
• Household contacts of infants less than 6 months old
• Pregnant women
• Health care workers
• People with health conditions (asthma; diabetes; etc.) putting them at high risk for flu complications

For those of you who have been hiding under a rock since Fall, the vaccine is being purchased and distributed by the government. This is as good an explanation as any as to why I have not been able to get ahold of any of the stuff.

Until now.

Finally, at long long last, I received an email from the state department of health notifying me that my order of 200 doses of H1N1 vaccine had been approved. Unfortunately, they were unable to provide me with a shipping date. They also sent me another mass email informing me that as of 12/11/09, they would be suspending all shipments (ostensibly, "for the holiday") and would resume 1/4/10.

Shit.

Then two days ago, I received a box from UPS. Inside, I found a plastic box. It was a sharps receptacle, a container specifically designed for safe disposal of hypodermic needles. I examined the package at length; the only other thing in the box was a sheet of paper naming the company that had sent the thing. The name rang a bell; sure enough, it was the company distributing H1N1 for the state. Given that the government was not only going to be providing the shots but also all the equipment and supplies for its administration, this was a very good sign indeed.

The next day brought another good sign: another delivery consisting of one box containing two plastic pouches, each containing one hundred syringes with attached needles, alcohol wipes, and little cards upon which flu shot administration could be documented and given to patients. This was an excellent sign!

Then earlier today, UPS came again. This time, the cardboard shipping box contained another box made of styrofoam. Hidden within, nestled among half a dozen cold packs, sat two shrink-wrapped packages of ten little cartons containing vials with 10 doses each of H1N1 vaccine. I'm in business!

(Eventually, I got back to check my email, and discovered that I had to print out and complete reporting forms for each dose given, and then send them back to the health department "in a timely fashion." I knew it couldn't be that easy.)

I was just finishing up with a patient as the vaccine was being delivered. Realizing what the package was likely to contain, and aware that the patient was undergoing cancer chemotherapy (a definite indication for H1N1 vaccination), I grabbed her before she could leave so I could get her immunized.

I tore open one of the government-supplied packages of syringes, and freed it from its paper overwrap. It was an unfamiliar design, but I figured that the basic idea is pretty universal. I drew up the first dose, half a milliliter of the treasured serum, and approached the patient's bare left upper arm.

I need to interject at this point that I'm damn good at giving shots. What I do is say, "Count to three" AS I'M GIVING THE SHOT. By the time they start to count, it's already done. I've given out about 300 seasonal flu shots this year so far, and the most common response to my injection technique is, "Was that it?" Even though I hadn't ever used this particular model of syringe/needle combo, I saw no need to alter my technique.

I swiped the site with alcohol and inserted the needle as I began to say, "Count to three." I depressed the plunger and watched as the vaccine disappeared into the tissue where it belonged. Suddenly, there was a loud SNAP as I finished the injection, and to my horror, there was no needle at the end of the syringe!

It is the essence of professionalism that the expression on my face never changed as the words, "Oh my fucking god, where did the needle go? Oh my fucking god, did I break the needle off in her arm??!? Oh my fucking god please no no no no no where did that fucking needle go???!?" raced through my mind, and my lab coat sucked all the way up to my splenic flexure.

I peered carefully at the patient's arm. Nothing out of the ordinary. But how could I tell if there was a needle broken off all the way under the skin? I poked at it gently.

"Does that hurt?" I asked the patient.

"A little," she answered.

I've had tiny glass shards stuck in my foot and they hurt like a mofo with the slightest pressure, so I thought it was unlikely that a broken-off needle would hurt just "a little."

Next I examined the syringe in my hand. I noticed that there was a stretched out spring within the barrel that I didn't remember seeing there earlier. Eventually, after a great deal of quizzical staring, I finally made out the needle and its clear plastic hub nestled safely within the syringe's hollow plunger. Clearly a brilliant design from the point of needle safety. On the other hand, it was downright hazardous to my cardiac health. The time it took to convince myself that I hadn't left an inch-long metal sliver in my patient's arm was marked by asystole and an adrenaline burst the likes of which I hadn't experienced in decades.

Finally, I began breathing again. First, I exhaled. Then I broke out in a sweat. Eventually I calmed down enough to get on with my day. I used the new syringes to give out several more shots, and even though I now knew what to expect, that SNAP still got me every time. I can only hope that I get used to it.

In the meantime, though: Hey everyone, I have H1N1! Come and get it.